The silos are collapsing.
That has been my mantra for the last 4 years.
By silos, I mean the isolated categories of industry. Design. Medicine. Pharmacy. Engineering. Their isolation is in part a result of the education system, with distinct departments that compartmentalize knowledge rather than generalize it.
By collapsing, I mean the following:
The value of being an expert in just one area is quickly declining. Most of the complex problems of the modern world cannot be addressed by knowledge of a small, isolated domain. Just think of global warming, the neurosciences, and the blending of personal/professional media. These are complex areas which require integrated, interdisciplinary approaches.
tl;dr: we're reaching the limits of monolithic education.
The strides we are making in individual fields are slowing. Instead, the strides from the areas in between fields are booming.
This is both an economic model and a truth. The economic model can be seen by companies such as Uber or Amazon - platforms which connect provider to consumer without directly providing those services themselves. The network NODES, as I'll call them, are static (the providers, the customers). Instead, it's the CONNECTORS that are driving value in the new economy.
In contrast to the economic model, the truth can be seen in the divide between old and new power. Old power involved ownership. Money. Wealth. Property. In a node-based world, those who exerted the most influence had resources at their disposal and utilized those resources.
However, we've seen a collapse of that model. Venture capital is becoming replaced by crowdsourcing, such as Kickstarter or GoFundMe. Old companies with established brands are being outmaneuvered by small start-ups that are more flexible in responding to shifting consumer demands. We're seeing the growth of new power, a power that comes from consuming 'likes' on social media and spreading ideas like a wildfire through a technologically interconnected world.
This disruption and instability of power comes at a cost. My own bias is that nationalist politics (e.g. Brexit and the recent American election) are a response to this quick shifting of wealth and power in the new economy. New power is more fluid that old power - and that comes at a cost. You have to be more resourceful in the new economy. Otherwise, you can rise just as quickly as you fall.
So is it enough to be a doctor on this shifting landscape? Will traditional pre-med courses give students the skills they need to be leaders on the cutting edge of healthcare?
My answer is a resounding 'NO.' Here are four healthcare-related domains that any university/college or pre-med student should take more seriously:
1. Computer Science
Optum, Google's health venture firm, cancer database registries... What do they have in common? Big data.
Health as a science is complex, and complexity makes it difficult to identify solutions. Building tools that interface with that complexity and simplify it will be the generators of medical progress and healthcare dollars for the foreseeable future.
For instance, medical imaging creates a signal for each area of space and converts that to a pixel. There are things we can see in those images with the human eye. But is it possible that there are small variations in that signal (things that can't be seen when all the pixels look nearly the same shade) that can predict a diagnosis, or the prognosis of a patient?
Consider also asking what socioeconomic factors lead to certain diseases, or to the risks of certain cancers.
Big data helps address questions just like this.
These tools will require that we pay attention to:
a) the data we collect from our patients and how we measure it
b) the outcomes we track over time and how we measure it
c) the software we build and what regression/data mining tools we use to understand that data and draw conclusions from it
d) how we generalize those conclusions and apply them to clinical practice
These four domains will require graduates versed in both computer science and medicine. Those proficient in both field's languages will excel. Those who are not will fall behind.
Gene silencing, retroviruses modifying DNA, gene-based therapies for cancer... These are all driven by an understanding of genetics and genetic technology.
It's a vast frontier - and potentially worth billions.
More importantly, it could also save hundreds of thousands of lives.
When I see companies such as Bluebird in Boston, or Genentech in California, I'm seeing companies that have learned to exploit a niche in the healthcare world. They are trying to see a horizon previously unexplored to drive new technology. There's an incredible amount of value there.
Virally-transforming red blood cells and transferring them back into the host as a bone marrow transplant? Using gene silencing technology in an effort to cure both oral and genital herpes? Targeting the brc-abl gene in CML and other cancers, and extending life by years?
These are all real, growing domains of research.
And when I hear about more specific technologies, such as those surrounding epigenetics, I see a field of knowledge almost entirely unexplored.
Be on the cutting edge. Learn it. Be it.
3. Public Health/Public Policy
CMS (Center for Medicare and Medicaid Services) recently rolled out MACRA. This bill represents a massive overhaul which will track reimbursement to physicians based on quality outcomes. Those who reach certain benchmarks on patient health will get more money, those who don't will receive less.
Great idea. Horrible design.
What you're not seeing here is the process behind the scenes. For one, the quality benchmarks in place have NOT been designed by consulting medical professionals, such as physicians. This would be like solving the 2008 financial crisis without asking for the advice of economists or bankers. A BAD idea.
And consider the following simplistic example of why this could be an issue: Let's say I am reimbursed more money if all of my patients have a low blood pressure. But for my 92-year-old grandma, having that low of a blood pressure might make her dizzy due to the medications necessary. She may trip and fall due to the medications we use, break her hip, and would likely die within the next 6 months.
This is why quality benchmarks fail when physicians are not a part of the design process.
A healthcare leader who knew public policy or public health would be INVALUABLE here. There are many patient advocacy groups, or healthcare-related arms, attempting to cooperate with government to create healthier patients. But you have to know POLITICS, the system and how to heal it, to effect this sort of change.
Consider also the following scenario - your hospital wants to secure federal and private money to build a large cancer research center. Or this scenario - plenty of patients can't reach the hospital due to public transit problems and need a bus or train that specifically comes to your hospital. Who do you approach? How do you get the taxpayer money to fund that?
You need skills - in public policy and public health.
Learn those skills early - and you'll be worth millions to the healthcare system that eventually hires you.
The best quote I ever heard from an attending physician was, "Healing is an art. Medicine is a science. Healthcare is a business."
Healthcare IS a business. And anyone who's worked in this business knows that the divide between the business-minded and the physician-minded has become deeper with time. There is an inherent tension here.
In response, we have recently seen an increase in the number of physician executives. While most healthcare executives were physicians in the mid-1960's, that number began to drop-off as government policies and new models of healthcare, such as HMOs, boomed. However, with the failures of those models, and a disconnect between the cost and value of healthcare, we've seen physician executives again on the rise.
Like how Steve Jobs understood that design should drive engineering which should drive the business of Apple - so we should understand that healing should drive medicine which should drive the business of healthcare. Being able to do that requires leaders who UNDERSTAND the art of healing. Who has touched a patient on the verge of death, or broken news of a cancer diagnosis, or healed a child with a previously fatal heart defect.
One of my favorite mentors, Dr. Georgieu, a physician and executive for many years at United Healthcare, once said, "I could have healed everyday for 30 years and touched 100,000 lives. But in business, I could touch millions. That's what guided my decision to enter the business world."
So my question for you is: do you want to heal hundreds - or do you want to heal millions?
Conclusion: Choose a Different Kind of Premed Major To Change Healthcare
Above we explored four great domains to explore as a pre-med student looking to build skills for the future of healthcare. However, this list is far from comprehensive.
For instance, English could teach you to communicate ideas through writing more effectively (think social media, newspaper columns on medicine, etc.). Art could give you another perspective on design, or just be functional for textbooks/illustrations (just look at Netter's anatomy textbook). The humanities have such an incredible amount to offer that I didn't even explore here. And in fact, there are hundreds of degrees that could be valuable. But the conclusion is clear.
Don't be a node. Be a connector.
The silos are collapsing.
For those with more interest, I would consider reading one of my academic publications, 'The Siloed Social Network,' for an exploration of how silos affect us in business and academic domains. It's a quick, but interesting, read.
What are your thoughts on my suggestions? Do you have any others? Do you think some of my ideas are misguided? If you're a premed, what degrees are you earning and why? Share your thoughts and comments below. Remember, commenting is one way to show search engines that this content matters to you. I know it matters to me.
Remember to share this post via email, Facebook, Twitter, or on social media with premeds or students who might benefit from it. These are not just my ideas. These are concepts reiterated to me by my mentors, healthcare leaders on the cutting edge of medicine.
And remember, healing is an art. Don't be afraid to get a little messy.
Internal medicine resident at NYU in New York City with an interest in heme / oncology (cancer care).